And So It Begins: Aetna/CVS pulling out of ACA exchanges next year as GOP allows IRA subsidies to expire

via Bruce Japsen at Forbes, the first shoe has dropped:

CVS Plans To Exit Obamacare In 2026, Affecting 1 Million Aetna Members

CVS Health plans to exit the individual health insurance business also known as Obamacare next year, leaving about 1 million Aetna members in 17 states looking for new coverage in 2026.

...CVS’ move to exit the individual insurance market comes as the Donald Trump White House and Republicans in Congress ponder cuts to health insurance benefits to pay for tax cuts for wealthy Americans. Trump has never been a fan of Obamacare, which he tried and failed several times to repeal in his first term, and his administration has already made moves to cut spending on such health benefits, already slashing what the federal government spends on navigators that help people sign up for Obamacare coverage.

Meanwhile, it remains unclear whether subsidies Americans use to buy individual coverage will remain once Congress has passed its budget.

Enhanced tax credits to buy Obamacare that were signed into law by former President Joe Biden run out at the end of this year, and there are questions about whether a Congress led by Republicans will extend them. Such tax credits contributed to record Obamacare enrollment of 24 million for this year.

...CVS has about 1 million people in its Aetna brand individual health insurance plans spread across 17 states. Those Aetna health plan members will have to purchase new coverage on the ACA’s exchanges this fall when insurers unveil their benefits for 2026.

Below I list the 17 states where CVS/Aetna is pulling out of the ACA market.

IMPORTANT: I've included my estimate of how many ACA exchange enrollees were in each state last year. This is important context because they add up to over 1.6 million enrollees even without New Jersey, which could be due to either a) Aetna losing significant market share in 2025 or b) the "1 million" figure mentioned in the Forbes article may not include off-exchange enrollees, who would also have to find new coverage assuming Aetna is pulling out of the off-exchange market as well.

Assuming the proportions are similar this year, knocking ~40% of each number below would give a rough idea of how many residents of each state are currently enrolled in Aetna/CVS plans who will have to switch to another carrier this fall:

• Arizona (Banner|Aetna): ~106,000 (~66K?)
• California: ~10,800 (~6.7K?)
• Delaware: ~4,000 (~2.5K?)
• Florida: ~565,000 (~353K?)
• Georgia: ~94,000 (~58K?)
• Illinois: ~42,000 (~26K?)
• Indiana: ~4,900 (~3.0K?)
• Kansas: ~22,200 (~13.8K?)
• Maryland: ~2,000 (~1.2K?)
• Missouri: ~35,900 (~22.4K?)
• Nevada: ~7,600 (~4.7K?)
• New Jersey: ~???
• North Carolina: ~280,900 (~175K?)
• Ohio: ~5,200 (~3.2K?)
• Texas: ~332,000 (~207K?)
• Utah: ~67,200 (~42K?)
• Virginia (as Innovation Health in some areas): ~41,700 (~26K?)

Again, it’s possible that Aetna’s ACA exchange market share has shifted around significantly since last year, but assuming it hasn’t, it’s likely to impact the most people in Arizona, Florida, North Carolina & Texas.

It's important to note that those million or so enrollees who'll now have to move to a different carrier are also going to have to do so at the same time that the Musk/Trump Regime is also cutting the Open Enrollment Period window nearly in half (from 76 days down to 45). This means that anyone who gets automatically "crosswalked" to a different exchange plan from a different carrier (potentially with a very different provider network) will be out of luck if they don't realize it before the earlier December 15th deadline.

They'll also have to do this while the Musk/Trump Regime is gutting the ACA's Navigator/Assister program funding by 90%, making it that much harder for confused enrollees to get ahold of someone to help them make the transition or understand the changes to their policy coverage.

Don't be surprised if this isn't the last announcement by an ACA carrier that they're bailing on the exchange market entirely (or at least reducing their footprint of where they offer coverage) over the next few months. Their actuaries are crunching the numbers right now to figure out what plans they plan on offering next year at what premium levels, and the likely expiration of the IRA subsidies on New Year's Eve is likely going to lead to millions of enrollees being priced out of the market.

UPDATE 5/2/25: I've created tables & graphics which break out how much ACA benchmark plan premiums will increase for typical households at different income levels in every state. Use the dropdown menu at the top to pick a state.